by Abbey Kim

This article was originally published in Arkansas Advocate.

County jails in Arkansas hold some of the state’s most vulnerable people, including many experiencing mental health crises.Hundreds are detained in county jails awaiting psychiatric treatment or evaluation, according to data from the Arkansas Department of Human Services. Once the cell door closes, navigating an overburdened jail system is the only way to get medical treatment.

U.S. law requires jails to provide adequate health services. In 1976, the Supreme Court held in Estelle v. Gamble that “deliberate indifference” to an incarcerated person’s serious injury or illness amounts to cruel and unusual punishment. In 2002, a federal district court in Arkansasaffirmed that Arkansas’ jails had to provide timely assessments, care and treatment.

But jails have varying responses to incarcerated people’s health needs, according to Dr. Anne Spaulding, founder of the Center for the Health of Incarcerated Persons at Emory University.

Often, the ideals of the law collide with the realities of county budgets, understaffed medical systems and already vulnerable jail populations. More than 75 people have died in Arkansas county jails since 2020, according to data obtained through a Freedom of Information Act request.

The Investigative Reporting Lab at Yale and the Arkansas Advocate conducted a statewide survey of jail medical and mental health coverage, revealing a fragmented system that relies heavily on private providers.

TK Health

Across Arkansas’ 75 counties, nearly every jail hires a private provider to deliver health care—ranging from an individually contracted nurse to a large health care company with dozens of staffers—according to a phone survey of county jails and sheriffs’ offices. Fifty county jail administrators disclosed the names of their individual providers to the Investigative Reporting Lab at Yale and the Advocate.

Eighteen Arkansas jails contract with TK Health, formerly Turn Key Health Clinics LLC, an Oklahoma-based provider that serves jails in 13 states. A jointinvestigation by The Marshall Project and The Frontier found that at least 50 people died under TK Health’s care between 2014 and 2024. The journalists reported that there were dozens of cases in which staff failed to send people in crisis to a hospital, a finding that TK Health disputes.

In Arkansas, TK Health first made headlines in 2021, after 51-year-old Larry Price Jr. died from acute dehydration and malnutrition in the Sebastian County Jail, where the company provides medical care. TK Health paid Price’s family a $3 million settlement and denied wrongdoing. (Sebastian County paid the family another $3 million.)

Since Price’s death, the company has reached settlements with the families of several others who died while under its care across the state. Death in custody documents obtained through a Freedom of Information Act request reveal that, over the past five years, more than a dozen people have died while in the custody of Arkansas jails and sheriffs’ offices that contract with TK Health.

“That doesn’t mean each of those patients died in the jail facility or while directly in our care. Some of them likely were transported to the hospital before they died,” Kenna Griffin, communications director for TK Health, wrote in an email. “Regardless, we agree that every death is a profound loss.”

In May, TK Health entered into a private settlement with the family of Brock Tyner, who died in 2024 while in the Craighead County Jail. Tyner had been arrested during a crisis intervention call, when a responding officer canceled an ambulance and arrested Tyner instead. He was placed in a restraint chair in the jail and became unresponsive, according to state filings obtained via a Freedom of Information Act request. TK Health denies wrongdoing in Tyner’s death.

In July, TK Health and Union County agreed to a settlement with undisclosed terms with the family of Eusebio Castillo Rodriguez, who died in a hospital from alcoholic liver disease after experiencing alcohol withdrawal in the county jail in 2022. In jail, he received treatment that one medical expert, hired by his family, described as “far below the acceptable standard of care.”

TK Health denies wrongdoing in his death, and Union County Sheriff Charlie Phillips faulted Rodriguez’s “dangerous life and health decisions” for both his death and the subsequent death of Rodricus Lewis.

In August, Brian Lewis filed a lawsuit against TK Health and Union County over the death of his father, a veteran with severe mental illness who died after losing more than 50 pounds in jail. Rodricus Lewis’ official cause of death was listed as ischemic heart disease complicated by COVID-19, but his son believes that starvation was a major factor in his father’s death.

TK Health cannot comment on ongoing litigation, according to Griffin. She cited the company’sresponse filed in the U.S. District Court in the Western District of Arkansas, in which TK Health denies that medical or mental health care was substandard or caused Lewis’ death. Sheriff Phillips denied wrongdoing and blamed Lewis, writing that it “became obvious that Mr. Lewis was suffering from mental health issues” but faulted him for being “combative and uncooperative.”

Despite the mounting litigation, counties across Arkansas continue to pay millions annually for TK Health’s services. The companyreported that its operational revenue climbed an average of 67% per year between 2014 and 2021. Healthcarecontracts reveal that Union County paid TK Health more than $220,000 for its services the year Lewis died. In 2025, Pulaski County paid the company about$6 million to provide care in its jail, which houses roughly 1,200 people. Sebastian County paid about$1.1 million for care in its 350-person jail.

Some family members of those who died would like to see a change in jail health care providers.

“I don’t think that Turn Key should be providing health care anymore,” Brian Lewis said, using TK Health’s previous name.

Lewis’ lawyer, Daniel Smolen, argues in his lawsuit that for a county, simply retaining TK Health for jail health care amounts to deliberate indifference toward the well-being of incarcerated people.

A Wider Network

Not all jails rely on large private companies. Many instead contract with individual nurses or doctors, who often come to jails for weekly visits.

Darrell Elkin, a nurse practitioner based in Hot Springs, knows the landscape well. Nearly three decades ago, he started his first company, Correctional Health Care, to fill what he saw as a huge need for health services in jails. Many jails did not contract any medical providers at all, Elkin said.

“Nobody was covering these jails,” Elkin said. “They were having to either ignore or neglect them. They didn’t have the manpower to send everybody to the clinic. I am a Christian, and there is a need. Someone needs to step up and take care of these guys.”

At the peak of operations, Elkin said he and his small team of nurses served 40 county and city jails across the state. In recent years, he dissolved his first company and scaled his own practice down.

Elkin now services 18 county and city jails in Arkansas under a new company, County Facility Healthcare of Arkansas LLC. In addition to working in a clinic in internal medicine, he spends two days per week traveling to the jails he serves, which are hundreds of miles away from one another. He said he visits each jail once a week and employs two nurses to visit an additional two times a week.

One of his former staffers, nurse practitioner Amy Stvartak, formed Western Arkansas Correctional Care LLC after the dissolution of Correctional Health Care. At least seven Arkansas jails contract with her, according to calls to jail administrators and sheriffs. Stvartak did not respond to a request for comment.

Elkin has faced nearly 100 lawsuits across 27 counties for his jail health services, according to federal court records. Most cases, filed directly by incarcerated people without lawyers, were dismissed on procedural grounds.

Burt Newell, Elkin’s lawyer, wrote in an email that Elkin has been practicing county correctional health care for more than 20 years, so he finds it unsurprising that Elkin has been sued that many times.

Elkin said that these lawsuits do not require medical records or documentation of alleged infractions to be filed. He believes that the threat of lawsuits and their resulting legal fees deter health providers from practicing in jails.

Elkin settled one lawsuit in 2012, alongside officials in Montgomery County, for an undisclosed amount. Mark Campbell, an incarcerated man who represented himself, wrote in his filed pro se complaint that he was denied anti-psychotic medication by Elkin and his jailers after self-harming and attempting suicide in the county jail. Instead of receiving medical and mental health support, Campbell wrote that guards pepper sprayed him, placed him in a straightjacket and kept him in isolation. Elkin denies wrongdoing.

Combining punitive systems with the provision of medical and mental health care can have troubling outcomes. And the thinly stretched network of jail health care providers reflects Arkansas’ broader shortages of licensed social workers, psychiatrists and nurses, compounded by lean county budgets. Jail health care is typically funded entirely by counties, leaving local quorum courts, which set county budgets, to decide how much they can afford.

“It’s the same old thing: if you don’t pay, people won’t come and play,” Chief Deputy Sheriff John Miller of Sebastian County said about jail health care workers. “Unfortunately, money’s the main motivator in a lot of jobs. And in jail nursing care, there’s not too many people who want to work in a jail.”

Before contracting with TK Health, Sebastian County ran its own health care programs between 2011 and 2018, according to Miller.

“That was a mess,” Miller said. The jail struggled with understaffing, turnover and burnout, he said.

But some critics argue that privatization has intensified these problems rather than solving them, by introducing a profit motive to the jail health care system.

“If you actually cared about the people in there, you would probably provide them better health care,” Brian Lewis said, “regardless of what the cost is.”

Brian Lewis’ attorney said that private health care companies can deploy legal tactics to avoid responsibility.

“When things get to just the absolute worst,” Smolen said of some private health care companies, “historically they’ll come in and try to file bankruptcy and then bankrupt out all the liability and all the death claims.”

Wellpath, formerly known as Correct Care Solutions, has secured a$1.5 billioncontract to provide health care across Arkansas prisons despite filing for Chapter 11 bankruptcy in November 2024. The company, which operates in 37 states across the country and cares for nearly 200,000 people, has faced more than 1,500 lawsuits claiming inadequate medical care of incarcerated people.

Spaulding said that public-sector models—where local or state health departments rather than correctional companies or sheriffs’ departments provide care to incarcerated people — show more promise.

“It’s not a panacea for health care just by having it under that authority,” she said. “But I think structurally that would probably be a stronger model than what we have.”

But such a transition would require political will—and money. Jail operations are already one of the largest financial burdens on county governments in Arkansas.

Still, the costs of the system are mounting across the country. Individual wrongful jail death settlements—paid by counties, with funds from local taxpayers—have crept into the tens of millions of dollars.

Smolen pointed to recent multimillion-dollar settlements after jail deaths in Oklahoma—$13.5 million in one county,$33 million in another. These settlements send a message to counties with inadequate jail health care, Smolen said.

“If they’re not going to put any money into the medical delivery system,” Smolen said, “they’re ultimately going to have to pay out in judgments for the people that die in the facilities.”

In Sebastian County, that message arrived with devastating clarity to then-Sheriff Hobe Runion after Larry Price Jr.’s death in 2021. Runion said his department doubled its jail medical budget after Price’s death and considered ending its contract with TK Health. The county fielded quotes from several other companies, but ultimately it concluded it couldn’t afford to switch providers, according to Runion.

“We can say [it was] too expensive,” Runion said. “Of course, the flip side of that would be: pay now or pay later.” 

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